The patient-physician relationship has always been recognized as an important therapeutic skill but methods to objectively describe and measure its effects have been lacking. The verbal interaction forms the core of the relationship, for through this interaction, patients express their symptoms and physicians explain the nature of the illness and its treatment. For the elderly, who have more medical problems in addition to more barriers to effective communication than the young, the verbal interaction may have special significance in a medical encounter. One of us (WBS) has developed a new taxonomy of verbal response modes which we have applied, in an initial study, to 52 patient-physician encounters in an adult medical clinic. In this study, we found that: a) the taxonomy reliably and accurately describes a medical encounter, and b) certain verbal response modes are positively correlated with one health outcome--patient satisfaction. In our proposed research, we will apply the taxonomy to 300 interactions in a study of approximately 150 patiets, stratified by age (20-29, 40-59, 60 or older). Each patient will have 2 encounteres coded. Four outcome measures--patient satisfaction, patient compliance, patient symptom status, and physician awareness of patients' symptoms--will be collected at each patient visit. Data will also be collected on patient expectations and illness characteristics. We will test hypotheses, based on our initial study, that certain verbal response modes will be related to the health outcomes; we will look for the modifying effects of patient expectations, age, and illness characteristics on these relationships. Finally, we will conduct a pilot study on the effect of training physicians to use verbal response modes positively correlated with health outcomes and to avoid modes negatively correlated. We hope to test the hypotheses that physicians can be trained to use certain verbal response modes, and that this training affects health outcomes.